Jorge Lobo's disease is a cutaneous and subcutaneous mycosis that affects patients in the Amazon region. The number of patients is relatively small, but the real situation of the disease as public ...health problem is not known, because Jorge Lobo's disease is not a notifiable disease. This study aims to report the clinical evolution in patients affected and to determine the prevalence and areas of occurrence of the disease. A retrospective study was carried out based on the analysis of the clinical records, which included a collection of photographs of patients in the Department of Sanitary Dermatology, in Rio Branco, and patients seen in the interior of the state. In a decade, in Rio Branco, 249 cases of the disease were reported, 30 were females and 219 males. Of these patients, 153 had localized lesions, 94 of them were on one ear, 55 had multifocal lesions and 41 had disseminated lesions. The average time between the onset of symptoms and diagnosis was 19 years. The average age at the time of diagnosis was 53 years, and ages ranged from 14 to 96 years.
Introduction: Early diagnosis of leprosy, including the diagnosis of sub-clinical disease in contacts of known cases, would be a major advance. The signs of early leprosy are often difficult to ...assess and a reliable diagnostic test could play an important role in identifying cases and thus reducing transmission. Methods: Subjects were recruited at Centro de Saude Jardim Guanabara, Rondonopolis, Mato Grosso State, Brazil. Sera were obtained from 174 recently diagnosed leprosy patients, 409 household contacts, 53 endemic controls and 12 patients with active TB. 186 of the household contacts were re-tested on subsequent visits. Both the NDO-LIDR rapid test (Orange LifeR, Rio de Janeiro, Brazil) and an anti-PGL-1 ELISA test were used on all samples for comparison. Results: LID-1 was positive in 25 of 125 PB cases (20%), but in 41 of 49 MB cases (83.7%), while the anti-PGL-1 ELISA was positive in 8 (6.4%) and 35 (71.4%) cases, respectively. Specificity for LID-1 was 85% and for the anti-PGL-1 ELISA, 97%. Amongst household contacts, 9 of 409 (2.2%) were positive on the LID-1 test, and a further 51 (12.5%) were weakly positive; although 9 cases of leprosy were subsequently identified amongst these contacts, 6 had tested negative, 2 were weakly positive and only 1 had been positive. Conclusion: The ND-O-LID-1 assay can be easily performed by the addition of serum to the assay device, and thus can be applied in resource-poor settings. The test was found to be useful for the detection of multibacillary cases, which in the long term will help to reduce transmission of the disease. This is a specific test, but it is not very sensitive for early detection of leprosy in household contacts and paucibacillary forms.
Leprosy, an infectious disease caused by Mycobacterium leprae, affects millions of people worldwide. However, little is known regarding its molecular pathophysiological mechanisms. In this study, a ...comprehensive assessment of human mRNA was performed on leprosy skin lesions by using DNA chip microarrays, which included the entire spectrum of the disease along with its reactional states. Sixty-six samples from leprotic lesions (10TT, 10BT, 10BB, 10BL, 4LL, 14R1, and 10R2) and nine skin biopsies from healthy individuals were used as controls (CC) (ages ranged from 06 to 83 years, 48 were male and 29 female). The evaluation identified 1580 differentially expressed mRNAs Fold Change (FC) ≥ 2.0, p ≤ 0.05 in diseased lesions vs. healthy controls. Some of these genes were observed in all forms of the disease (CD2, CD27, chit1, FA2H, FAM26F, GZMB, MMP9, SLAMF7, UBD) and others were exclusive to reactional forms (Type "1" reaction: GPNMB, IL1B, MICAL2, FOXQ1; Type "2" reaction: AKR1B10, FAM180B, FOXQ1, NNMT, NR1D1, PTX3, TNFRSF25). In literature, these mRNAs have been associated with numerous pathophysiological processes and signaling pathways and are present in a large number of diseases. The role of these mRNAs maybe studied in the context of developing new diagnostic markers and therapeutic targets for leprosy.
Jorge Lobo's disease (Lacaziosis) is a subcutaneous infection of humans living in the Amazon region of Latin America, and in dolphins inhabiting the east coastal areas of the United States. The ...disease mainly affects people from rural areas living or working in close contact with vegetation and aquatic environments. Most patients refer having developed lesions after accidental trauma with plant thorns or insect bites. Inter-human transmission has never been confirmed suggesting that Lacazia loboi is acquired from environmental propagules.
We report the case of a 41-year-old woman from São Paulo, Brazil, a non-endemic area of Jorge Lobo's disease, with L. loboi skin infection most likely accidentally acquired while manipulating experimentally infected mice in the laboratory.
Because many patients with Jorge Lobo's disease do not recall accidental skin trauma before their infections, the possibility of accidentally acquired Jorge Lobo's disease through unnoticed broken skin should be considered during the clinical investigation of nodular skin diseases in people who have contact with the fungus or who live in endemic areas. This is the second report of animal to human transmission of this disease.
Summary Background Procedures involving the use of Mycobacterium leprae and Lacazia loboi , uncultivated organisms, depend on the collection of material from the lesions of patients or experimental ...animals. This study compared fine-needle aspiration (FNA) and skin biopsy methods for obtaining bacilli and fungal cells to experimentally infect animals. Methods Lepromas from one armadillo and one enlarged footpad of a mouse previously inoculated with L. loboi were submitted to FNA and biopsy. Materials collected were processed for inoculation in mice. Results Acid-fast bacilli (AFB) collected by two FNA procedures yielded 7.2 × 107 and 5.3 × 106 AFB/ml and biopsies yielded 1.58 × 108 and 3.5 × 108 AFB/ml from each leproma. Yeast-like cells of L. loboi collected by FNA yielded 1.0 × 106 fungal cells/ml and biopsy 1.0 × 107 fungal cells/ml. After 8 months, inoculated animals were sacrificed and the inoculated footpads submitted to histopathological examination and counting of AFB and fungal cells. The results obtained by the two methods were comparable for both microorganisms. Conclusions Biopsy may be replaced by FNA during harvesting of material for different purposes, especially for experimental inoculation of mice in leprosy and Jorge Lobo's disease, with the advantage of FNA being a simpler, less invasive, and less costly method.
Although multidrug therapy is considered an effective treatment for leprosy, antimicrobial resistance is a serious concern. We performed a systematic review of studies on the diagnostic accuracy and ...screening of tests for antimicrobial resistance in leprosy. This review was registered in PROSPERO (CRD42020177958). In April 2020, we searched for studies in the PubMed, EMBASE, Web of Science, Scopus, Scielo, and LILACS databases. A random effects regression model was used for the meta-analysis. We included 129 studies. Molecular tests for dapsone resistance had a sensitivity of 78.8% (95% confidence interval CI = 65.6–87.9) and a specificity of 97.0% (95% CI = 94.0–98.6). Molecular tests for rifampicin resistance had a sensitivity and specificity of 88.7% (95% CI = 80.0–93.9) and 97.3% (95% CI = 94.3–98.8), respectively. Molecular tests for ofloxacin resistance had a sensitivity and specificity of 80.9% (95% CI = 60.1–92.3) and 96.1% (95% CI = 90.2–98.5), respectively. In recent decades, no increase in the resistance proportion was detected. However, the growing number of resistant cases is still a clinical concern.
A poliquimioterapia/Organização Mundial da Saúde foi implantada efetivamente no Brasil em 1991, contribuindo drasticamente para redução da taxa de prevalência e cura da hanseníase. No entanto, a sua ...comprovada eficácia não tem impedido a ocorrência de recidiva da doença. Falha no tratamento, persistência bacilar ou resistência a drogas são fatores que podem ou não estarem associados a ela. O objetivo deste estudo foi verificar a ocorrência de recidiva e associá-la com a presença de cepas resistentes do Mycobacterium leprae entre 28 indivíduos que apresentaram suspeita clínica de recidiva após tratamento por monoterapia sulfônica, esquema da Divisão Nacional de Dermatologia Sanitária ou poliquimioterapia. Biópsias das lesões de pacientes multibacilares, com diagnóstico clínico de recidiva, atendidos por demanda espontânea, foram coletadas para avaliar resistência a drogas por meio da técnica de inoculação em pata de camundongo. Dentre as amostras avaliadas 42,8% apresentaram bacilos sensíveis à dapsona e rifampicina e 10,7% apresentaram resistência à dapsona; não foram isolados bacilos resistentes à rifampicina. A emergência de bacilos resistentes, especialmente à rifampicina, é um alerta para os programas de controle da hanseníase. Monitorar a disseminação destas cepas é importante, pois elas apresentam um sério obstáculo para a eliminação da doença, principalmente em países onde a hanseníase ainda é endêmica.
PDF
